title: The association between tramadol hydrochloride misuse and other substances use in an adolescent population: Phase I of a prospective survey.
abstract: BACKGROUND
  Tramadol hydrochloride is a common prescription pain reliever that is structurally similar to morphine and codeine with its analgesic effects identified as a mu-receptor agonist. Due to its opioid-like stimulant effects, the potential for tramadol misuse is a public health concern. As such, the aim of this investigation is to estimate the prevalence of tramadol misuse in a sample of Iranian adolescents and to assess the relationship between tramadol misuse and other substance use.
  
  
  METHODS
  This is the first phase of a prospective survey examining the prevalence of adolescent smoking status, substances use and related factors in Ilam city, Iran. Grade 10 male and female students (n=2000) were recruited using multistage sampling. Self-administered multiple-choice questionnaires were conducted with data analysed using cross tabulations and logistic regression models.
  
  
  RESULTS
  The prevalence of lifetime tramadol misuse was 4.8% (7.6% males; 1.8% females). Adjusted odds ratios and confidence intervals for lifetime tramadol misusers reporting substance use during the past month were 2.2 (1.1-4.4) for alcohol, 5.0 (1.5-21.9) for cannabis, 8.9 (2.7-29.4) for ecstasy, 0.5 (0.03-7.0) for methamphetamine and 2.3 (0.7-7.4) for opium.
  
  
  CONCLUSIONS
  Tramadol could be a related factor or co-factor for adolescent alcohol, cannabis and ecstasy use. We recommend future longitudinal studies to investigate the possible role of tramadol as a gateway drug in the development of substance abuse.
authors.affiliation: Shahid Beheshti University of Medical Sciences, Department of Epidemiology, Tehran, Iran; Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran. Electronic address: Nazarzadeh_milad@yahoo.com.
authors.forename: Milad
authors.initials: M
authors.lastname: Nazarzadeh
authors.forename: Zeinab
authors.initials: Z
authors.lastname: Bidel
authors.forename: Kristin V
authors.initials: KV
authors.lastname: Carson
mesh_terms: D000293:Adolescent; D000428:Alcohol Drinking / Q000453:epidemiology*; D019969:Amphetamine-Related Disorders / Q000453:epidemiology; D000701:Analgesics, Opioid; D005260:Female; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D008385:Marijuana Smoking / Q000453:epidemiology*; D008694:Methamphetamine; D018817:N-Methyl-3,4-methylenedioxyamphetamine; D016017:Odds Ratio; D009293:Opioid-Related Disorders / Q000453:epidemiology; D009892:Opium; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D015995:Prevalence; D011446:Prospective Studies; D017678:Sex Distribution; D019966:Substance-Related Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014147:Tramadol
chemical_list: D000701:Analgesics, Opioid; D014147:Tramadol; D008694:Methamphetamine; D009892:Opium; D018817:N-Methyl-3,4-methylenedioxyamphetamine
keywords: Adolescents; Iran; Substances use; Tramadol